uzspbgmuУчёные записки Первого Санкт-Петербургского государственного медицинского университета имени академика И. П. ПавловаThe Scientific Notes of the Pavlov University1607-41812541-8807Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1607-4181-2022-29-4-89-98uzspbgmu-929Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESВыбор оптимальной тактики лечения пострадавших с тяжелой нестабильной травмой тазаDeciding on the optimal treatment protocol for patients with severe unstable pelvic traumahttps://orcid.org/0000-0002-8961-2841ГвенетадзеВ. В.GvenetadzeV. V.

Гвенетадзе Вадим Валерианович, аспирант кафедры травматологии и ортопедии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Gvenetadze V. V., Postgraduate Student of the Department of Traumatology and Orthopedics

6-8 L’va Tolstogo str., Saint Petersburg, 197022

vadimgven@gmail.comhttps://orcid.org/0000-0003-4079-5541ДулаевА. К.DulaevA. K.

Дулаев Александр Кайсинович, доктор медицинских наук, профессор, заведующий кафедрой травматологии и ортопедии

Санкт-Петербург

Dulaev A. K., Dr. of Sci. (Med), Professor, Head of the Department of Traumatology and Orthopedics

Saint Petersburg

akdulaev@gmail.comhttps://orcid.org/0000-0001-8392-5380ЦедА. Н.TsedA. N.

Цед Александр Николаевич, доктор медицинских наук, профессор кафедры травматологии и ортопедии

Санкт-Петербург,

Tsed A. N., Dr. of Sci. (Med), Professor of the Department of Traumatology and Orthopedics

Saint Petersburg

travma1@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov UniversityRussian Federation2022281120222948998Copyright © Гвенетадзе В.В., Дулаев А.К., Цед А.Н., 20232023Гвенетадзе В.В., Дулаев А.К., Цед А.Н.Gvenetadze V.V., Dulaev A.K., Tsed A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sci-notes.ru/jour/article/view/929

На долю переломов таза, вызванных действием высокоэнергетических сил, приходится от 3 до 8 % всех травматических переломов костей. Эти травмы часто сопровождаются другими жизнеугрожающими повреждениями, представляя собой серьезную тактическую проблему. Имеется большое количество публикаций, посвященных преимуществам и недостаткам многоэтапной тактики оказания помощи Damage Control Orthopedics и ранней полной хирургической помощи Early Total Care. Однако наиболее трудной в отношении выбора тактики является категория пострадавших, находящихся в пограничном или гемодинамически нестабильном состоянии. Их лечение зачастую осложняется такими состояниями, как острый респираторный дистресс-синдром (ОРДС) и полиорганная недостаточность (ПОН). Критерии оценки рисков, связанных с применением одноэтапной и многоэтапной тактики лечения пострадавших с нестабильной травмой таза, не определены в достаточной мере, и хирург вынужден самостоятельно принимать решение о выборе тактики лечения, основываясь в большей степени на собственный опыт.

Цель – проанализировать результаты применения одноэтапной и многоэтапной тактик лечения пострадавших с нестабильной травмой таза, а также определить недостаточно исследованные аспекты каждой из них.

Pelvic trauma caused by high-energy forces are accounting for 3 % to 8 % of all traumatic fractures. These are often accompanied by other life-threatening injuries that is a serious tactic problem. There are many publications on the advantages and disadvantages of multi-stage treatment with the Damage Control Orthopedics protocol and Early Total Surgical Care. However, the most difficult category was those who are in a borderline or hemodynamically unstable state.

Their treatment is often complicated by acute respiratory distress syndrome (ARDS) and multiple organ failure syndrome (MOFS). The reliable risk assessment, associated with the implementation of a single-stage or multi-stage treatment protocol in patients with unstable pelvic injury, is not sufficient, and surgeon has to choose the treatment protocol based only on own experience.

The objective was to analyze the results of using single-stage and multi-stage treatment protocols for patients with unstable pelvic trauma and identify insufficiently researched aspects of each of them.

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The authors declare that there are no conflicts of interest present.